Free Authorization Form (PLRA) - District Court of Delaware - Delaware

Case1:06-cv-00017-GIVIS D0cument6 Filed 04/14/2006 Page10f2
IN THE UNIT D STATES DISTRICT COURT
FOR THE 7ISTRICT OF DELAWARE
JAY M. RINGGOLD, SR. I
I
Plaintiff, I
I
v. ) Civil Action No. 06—0l7—GMS
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I
WILMINGTON POLICE DEPARTMEZ , I
OFFICER THOMAS CURLEY, l
~ I E .ELIN A VEGA,
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Defendants. I _
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DISTRICT OF DELAWARE
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I, Jay M. Ringgold, Sr., SBI #324847 request and authorize
the agency holding me in custody to disburse to the Clerk of the
Court the initial partial filing fee of $3.5.17 and the subsequent
payments pursuant to 28 0.5.C. § l9l5(b) and required by the
(”W
Court’s order dateo’< 2§@}£$,»;‘g' Q , 2006.
This authorization is furnished to the Clerk of Court in
connection with the filing of a civil action, and I understand
that the filing tee for th. complaint is $250.00. I also
understand that the entire tiling fee may be deducted from my
trust account regardless o' the outcome of my civil action. This
authorization shall apply *o any other agency into whose custody
I may be transferred.
tiara; __/ _g_.2__;f_;L;_,;.I;j_.__ 2006.
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Si na ure of P intiff

Case D0cument6 Filed 04/14/2006 Page20f2
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